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REPOR T OF THE C O MMISSIO NERSGLOBAL COMMISSION Asma Jahangir, human rights activist, former UN Special Rapporteur on Arbitrary, Extrajudicial andON DRUG POLICY Summary Executions, Pakistan Carlos Fuentes, writer and public intellectual, Mexico César Gaviria, former President of Colombia Ernesto Zedillo, former President of Mexico Fernando Henrique Cardoso, former President ofTo learn more about the Commission, visit: Brazil (chair)www.globalcommissionondrugs.org George Papandreou, Prime Minister of GreeceOr email: declaration@globalcommissionondrugs.org George P. Shultz, former Secretary of State, United States (honorary chair) Javier Solana, former European Union High Representative for the Common Foreign and Security Policy, Spain John Whitehead, banker and civil servant, chair of the World Trade Center Memorial Foundation, United States Kofi Annan, former Secretary General of the United Nations, Ghana Louise Arbour, former UN High Commissioner for Human Rights, President of the International Crisis Group, Canada Maria Cattaui, Petroplus Holdings Board member, former Secretary-General of the International Chamber of Commerce, Switzerland Mario Vargas Llosa, writer and public intellectual, Peru Marion Caspers-Merk, former State Secretary at the German Federal Ministry of Health Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, France Paul Volcker, former Chairman of the United States Federal Reserve and of the Economic Recovery Board Richard Branson, entrepreneur, advocate for social causes, founder of the Virgin Group, co-founder of The Elders, United Kingdom Ruth Dreifuss, former President of Switzerland and Minister of Home Affairs Thorvald Stoltenberg, former Minister of Foreign Affairs and UN High Commissioner for Refugees, Norway

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EXE CU T IVE SUMMARYThe global war on drugs has failed, with Our principles and recommendations candevastating consequences for individuals be summarized as follows:and societies around the world. Fifty years after the initiation of the UN Single End the criminalization, marginalizationConvention on Narcotic Drugs, and and stigmatization of people who use drugs40 years after President Nixon launched but who do no harm to others. Challengethe US government’s war on drugs, rather than reinforce common misconceptionsfundamental reforms in national and global about drug markets, drug use anddrug control policies are urgently needed. drug dependence. Vast expenditures on criminalization and Encourage experimentation by governmentsrepressive measures directed at producers, with models of legal regulation of drugs totraffickers and consumers of illegal drugs undermine the power of organized crimehave clearly failed to effectively curtail and safeguard the health and security ofsupply or consumption. Apparent victories their citizens. This recommendation appliesin eliminating one source or trafficking especially to cannabis, but we also encourageorganization are negated almost instantly other experiments in decriminalization andby the emergence of other sources and legal regulation that can accomplish thesetraffickers. Repressive efforts directed at objectives and provide models for others.consumers impede public health measuresto reduce HIV/AIDS, overdose fatalities Offer health and treatment services to thoseand other harmful consequences of in need. Ensure that a variety of treatmentdrug use. Government expenditures on modalities are available, including not justfutile supply reduction strategies and methadone and buprenorphine treatment butincarceration displace more cost-effective also the heroin-assisted treatment programsand evidence-based investments in that have proven successful in many Europeandemand and harm reduction. countries and Canada. Implement syringe access and other harm reduction measures that have proven effective in reducing transmission of HIV and other blood-borne infections as well as fatal overdoses. Respect the human rights of people who use drugs. Abolish abusive practices carried out in the name of treatment – such as forced detention,2 Global Commission on Drug Policy

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forced labor, and physical or psychological Focus repressive actions on violentabuse – that contravene human rights criminal organizations, but do so in waysstandards and norms or that remove the that undermine their power and reachright to self-determination. while prioritizing the reduction of violence and intimidation. Law enforcementApply much the same principles and efforts should focus not on reducing drugpolicies stated above to people involved markets per se but rather on reducing theirin the lower ends of illegal drug markets, harms to individuals, communities andsuch as farmers, couriers and petty sellers. national security.Many are themselves victims of violenceand intimidation or are drug dependent. Begin the transformation of the globalArresting and incarcerating tens of millions drug prohibition regime. Replace drugof these people in recent decades has filled policies and strategies driven by ideologyprisons and destroyed lives and families and political convenience with fiscallywithout reducing the availability of illicit responsible policies and strategiesdrugs or the power of criminal organizations. grounded in science, health, security andThere appears to be almost no limit to human rights – and adopt appropriatethe number of people willing to engage in criteria for their evaluation. Review thesuch activities to better their lives, provide scheduling of drugs that has resultedfor their families, or otherwise escape in obvious anomalies like the flawedpoverty. Drug control resources are better categorization of cannabis, coca leaf anddirected elsewhere. MDMA. Ensure that the international conventions are interpreted and/or revisedInvest in activities that can both prevent to accommodate robust experimentationyoung people from taking drugs in the with harm reduction, decriminalization andfirst place and also prevent those who do legal regulatory policies.use drugs from developing more serious problems. Eschew simplistic ‘just say no’ Break the taboo on debate and reform.messages and ‘zero tolerance’ policies The time for action is now.in favor of educational efforts grounded in credible information and preventionprograms that focus on social skills and peerinfluences. The most successful preventionefforts may be those targeted at specificat-risk groups. Global Commission on Drug Policy 3

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INTR ODUC T IO NU N I TE D N ATIONS E S TIMATE S O F ANNUAL DRUGCO N S U MPTION, 1998 TO 2008 Opiates Cocaine Cannabis1998 12.9 million 13.4 million 147.4 million2008 17.35 million 17 million 160 million% Increase 34.5% 27% 8.5%The global war on drugs has failed. When the United This lack of leadership on drug policy has prompted theNations Single Convention on Narcotic Drugs came into establishment of our Commission, and leads us to our viewbeing 50 years ago, and when President Nixon launched the that the time is now right for a serious, comprehensiveUS government’s war on drugs 40 years ago, policymakers and wide-ranging review of strategies to respond to thebelieved that harsh law enforcement action against those drug phenomenon. The starting point for this review isinvolved in drug production, distribution and use would the recognition of the global drug problem as a set oflead to an ever-diminishing market in controlled drugs interlinked health and social challenges to be managed,such as heroin, cocaine and cannabis, and the eventual rather than a war to be won.achievement of a ‘drug free world’. In practice, the globalscale of illegal drug markets – largely controlled by Commission members have agreed on four core principlesorganized crime – has grown dramatically over this period. that should guide national and international drug policiesWhile accurate estimates of global consumption across the and strategies, and have made eleven recommendationsentire 50-year period are not available, an analysis of the for action.last 10 years alone1,2,3,4 shows a large and growing market.(See chart above.)In spite of the increasing evidence that current policies arenot achieving their objectives, most policymaking bodiesat the national and international level have tended to avoidopen scrutiny or debate on alternatives.4 Global Commission on Drug Policy

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P RINCIP L ES1. Drug policies must be based on solid empirical and 2. Drug policies must be based on human rights scientific evidence. The primary measure of success and public health principles. We should end the should be the reduction of harm to the health, stigmatization and marginalization of people who security and welfare of individuals and society. use certain drugs and those involved in the lower levels of cultivation, production and distribution, In the 50 years since the United Nations initiated a truly and treat people dependent on drugs as patients, global drug prohibition system, we have learned much not criminals. about the nature and patterns of drug production, distribution, use and dependence, and the effectiveness Certain fundamental principles underpin all aspects of of our attempts to reduce these problems. It might have national and international policy. These are enshrined been understandable that the architects of the system in the Universal Declaration of Human Rights and many would place faith in the concept of eradicating drug international treaties that have followed. Of particular production and use (in the light of the limited evidence relevance to drug policy are the rights to life, to health, available at the time). There is no excuse, however, for to due process and a fair trial, to be free from torture ignoring the evidence and experience accumulated or cruel, inhuman or degrading treatment, from slavery, since then. Drug policies and strategies at all levels too and from discrimination. These rights are inalienable, often continue to be driven by ideological perspectives, and commitment to them takes precedence over other or political convenience, and pay too little attention international agreements, including the drug control to the complexities of the drug market, drug use and conventions. As the UN High Commissioner for Human drug addiction. Rights, Navanethem Pillay, has stated, “Individuals who use drugs do not forfeit their human rights. Too Effective policymaking requires a clear articulation of the often, drug users suffer discrimination, are forced to policy’s objectives. The 1961 UN Single Convention on accept treatment, marginalized and often harmed by Narcotic Drugs made it clear that the ultimate objective approaches which over-emphasize criminalization and of the system was the improvement of the ‘health and punishment while under-emphasizing harm reduction welfare of mankind’. and respect for human rights.”5 This reminds us that drug policies were initially A number of well-established and proven public developed and implemented in the hope of achieving health measures6,7 (generally referred to as harm outcomes in terms of a reduction in harms to individuals reduction, an approach that includes syringe access and and society – less crime, better health, and more treatment using the proven medications methadone or economic and social development. However, we have buprenorphine) can minimize the risk of drug overdose primarily been measuring our success in the war on deaths and the transmission of HIV and other blood- drugs by entirely different measures – those that report borne infections.8 However, governments often do not on processes, such as the number of arrests, the fully implement these interventions, concerned that by amounts seized, or the harshness of punishments. These improving the health of people who use drugs, they indicators may tell us how tough we are being, but they are undermining a ‘tough on drugs’ message. This is do not tell us how successful we are in improving the illogical – sacrificing the health and welfare of one group ‘health and welfare of mankind’. of citizens when effective health protection measures are available is unacceptable, and increases the risks faced by the wider community. Global Commission on Drug Policy 5

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P RINC IP L ES (Continued) IMPA C T OF D R UG POLICIE S Countries that implemented harm reduction and public health strategies early have experienced consistently low O N R E CE NT H IV PR E VALE NCE rates of HIV transmission among people who inject drugs. A MO N G PE OPLE WH O Similarly, countries that responded to increasing HIV prevalence among drug users by introducing harm reduction IN JE C T D R U GS 9 programs have been successful in containing and reversing the further spread of HIV. On the other hand, many countries Sample of countries that have consistently that have relied on repression and deterrence as a response implemented comprehensive harm reduction to increasing rates of drug-related HIV transmission are strategies: experiencing the highest rates of HIV among drug using populations.10,11,12 UK An indiscriminate approach to ‘drug trafficking’ is similarlySwitzerland problematic. Many people taking part in the drug market are themselves the victims of violence and intimidation, or are Germany dependent on drugs. An example of this phenomenon are the drug ‘mules’ who take the most visible and risky roles in Australia the supply and delivery chain. Unlike those in charge of drug 0 5 10 15 20 25 30 35 40 45 trafficking organizations, these individuals do not usually have % HIV prevalence among people who inject drugs an extensive and violent criminal history, and some engage in the drug trade primarily to get money for their own drug dependence. We should not treat all those arrested for Sample of countries that have introduced harm trafficking as equally culpable – many are coerced into their reduction strategies partially, or late in the actions, or are driven to desperate measures through their progress of the epidemic: own addiction or economic situation. It is not appropriate to punish such individuals in the same way as the members of USA violent organized crime groups who control the market. Portugal Finally, many countries still react to people dependent on drugs with punishment and stigmatization. In reality, drug Malaysia dependence is a complex health condition that has a mixture of causes – social, psychological and physical (including, for France example, harsh living conditions, or a history of personal 0 5 10 15 20 25 30 35 40 45 trauma or emotional problems). Trying to manage this % HIV prevalence among people who inject drugs complex condition through punishment is ineffective – much greater success can be achieved by providing a range of evidence-based drug treatment services. Countries that have Sample of countries that have consistently treated citizens dependent on drugs as patients in need of resisted large scale implementation of harm treatment, instead of criminals deserving of punishment, have reduction strategies, despite the presence of demonstrated extremely positive results in crime reduction, drug injecting and sharing: health improvement, and overcoming dependence. Thailand Russia 0 5 10 15 20 25 30 35 40 45 % HIV prevalence among people who inject drugs 6 Global Commission on Drug Policy

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PAT IE N TS NOT CR IMINALS : A MO R E H UMANE AND E F F E CT IVE AP P RO AC H Case Study One: Switzerland13 Case Study Two: United Kingdom15 In response to severe and highly visible drug Research carried out in the UK into the effects problems that developed across the country in of their policy of diversion from custody into the 1980s, Switzerland implemented a new set of treatment programs clearly demonstrated a policies and programs (including heroin substitution reduction in offending following treatment programs) based on public health instead of intervention. In addition to self-reports, the criminalization. The consistent implementation researchers in this case also referred to police of this policy has led to an overall reduction in criminal records data. The research shows the number of people addicted to heroin as well that the numbers of charges brought against as a range of other benefits. A key study14 1,476 drug users in the years before and after concluded that: entering treatment reduced by 48 percent. “Heroin substitution targeted hard-core Case Study Three: The Netherlands16,17,18 problematic users (heavy consumers) – assuming that 3,000 addicts represent 10 percent to Of all EU-15 countries, the percentage of people 15 percent of Switzerland’s heroin users that may who inject heroin is the lowest in the Netherlands account for 30 percent to 60 percent of the demand and there is no new influx of problematic users. for heroin on illegal markets. Heavily engaged in Heroin has lost its appeal to the mainstream youth both drug dealing and other forms of crime, they and is considered a ‘dead-end street drug’. also served as a link between wholesalers and users. The number of problematic heroin users has As these hard-core users found a steady, legal dropped significantly and the average age of users means for their addiction, their illicit drug use was has risen considerably. Large-scale, low-threshold reduced as well as their need to deal in heroin drug treatment and harm reduction services and engage in other criminal activities. include syringe access and the prescription of methadone and heroin under strict conditions. The heroin substitution program had three effects on the drug market: Medically prescribed heroin has been found• It substantially reduced the consumption among in the Netherlands to reduce petty crime and the heaviest users, and this reduction in demand public nuisance, and to have positive effects on affected the viability of the market. (For example, the health of people struggling with addiction. the number of new addicts registered in Zurich In 2001, the estimated number of people in the in 1990 was 850. By 2005, the number had Netherlands dependent on heroin was 28-30,000. fallen to 150.) By 2008, that number had fallen to 18,000.• It reduced levels of other criminal activity The Dutch population of opiate users is in the associated with the market. (For example, there process of aging – the proportion of young was a 90 percent reduction in property crimes opiate users (aged 15-29) receiving treatment for committed by participants in the program.) addiction has also declined.• By removing local addicts and dealers, Swiss casual users found it difficult to make contact with sellers.” Global Commission on Drug Policy 9

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P RINCIP L ES (Continued)3. The development and implementation of drug A current example of this process (what may be described policies should be a global shared responsibility, as ‘drug control imperialism’), can be observed with the but also needs to take into consideration diverse proposal by the Bolivian government to remove the political, social and cultural realities. Policies should practice of coca leaf chewing from the sections of the respect the rights and needs of people affected 1961 Convention that prohibit all non-medical uses. by production, trafficking and consumption, as Despite the fact that successive studies have shown19 that explicitly acknowledged in the 1988 Convention the indigenous practice of coca leaf chewing is associated on Drug Trafficking. with none of the harms of international cocaine markets, and that a clear majority of the Bolivian population (and The UN drug control system is built on the idea that neighboring countries) support this change, many of the all governments should work together to tackle drug rich ‘cocaine consumer’ countries (led by the US) have markets and related problems. This is a reasonable formally objected to the amendment.20 starting point, and there is certainly a responsibility to be shared between producing, transit and consuming The idea that the international drug control system is countries (although the distinction is increasingly blurred, immutable, and that any amendment – however reasonable as many countries now experience elements of all three). or slight – is a threat to the integrity of the entire system, is short-sighted. As with all multilateral agreements, the However, the idea of shared responsibility has too often drug conventions need to be subject to constant review become a straitjacket that inhibits policy development and modernization in light of changing and variable and experimentation. The UN (through the International circumstances. Specifically, national governments must Narcotics Control Board), and in particular the US be enabled to exercise the freedom to experiment with (notably through its ‘certification’ process), have worked responses more suited to their circumstances. This analysis strenuously over the last 50 years to ensure that all and exchange of experiences is a crucial element of the countries adopt the same rigid approach to drug policy process of learning about the relative effectiveness of – the same laws, and the same tough approach to their different approaches, but the belief that we all need to have enforcement. As national governments have become exactly the same laws, restrictions and programs has been more aware of the complexities of the problems, and an unhelpful restriction. options for policy responses in their own territories, many have opted to use the flexibilities within the Conventions to try new strategies and programs, such as decriminalization initiatives or harm reduction programs. When these involve a more tolerant approach to drug use, governments have faced international diplomatic pressure to ‘protect the integrity of the Conventions’, even when the policy is legal, successful and supported in the country. 8 Global Commission on Drug Policy

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U N I N TE N D E D CONS E QUE NCES Although governments have increasingly recognized that law enforcement strategies for drug control need to be The implementation of the war on drugs has generated integrated into a broader approach with social and public widespread negative consequences for societies in health programs, the structures for policymaking, budget producer, transit and consumer countries. These allocation, and implementation have not modernized at negative consequences were well summarized by the the same pace. former Executive Director of the United Nations Office on Drugs and Crime, Antonio Maria Costa, as falling into These institutional dynamics obstruct objective and five broad categories: evidence-based policymaking. This is more than a theoretical problem – repeated studies22,23 have1. The growth of a ‘huge criminal black market’, financed demonstrated that governments achieve much greater by the risk-escalated profits of supplying international financial and social benefit for their communities by demand for illicit drugs. investing in health and social programs, rather than2. Extensive policy displacement, the result of using scarce investing in supply reduction and law enforcement activities. resources to fund a vast law enforcement effort intended However, in most countries, the vast majority of available to address this criminal market. resources are spent on the enforcement of drug laws and3. Geographical displacement, often known as ‘the balloon the punishment of people who use drugs.24 effect’, whereby drug production shifts location to avoid the attentions of law enforcement. The lack of coherence is even more marked at the4. Substance displacement, or the movement of consumers United Nations. The development of the global drug to new substances when their previous drug of choice control regime involved the creation of three bodies to becomes difficult to obtain, for instance through law oversee the implementation of the conventions – the UN enforcement pressure. Office on Drugs and Crime (UNODC), the International5. The perception and treatment of drug users, who are Narcotics Control Board (INCB), and the Commission on stigmatized, marginalized and excluded.21 Narcotic Drugs (CND). This structure is premised on the notion that international drug control is primarily a fight against crime and criminals. Unsurprisingly, there is a built-in vested interest in maintaining the law enforcement focus and the senior decisionmakers in these bodies have4. Drug policies must be pursued in a comprehensive traditionally been most familiar with this framework. manner, involving families, schools, public health specialists, development practitioners and civil society Now that the nature of the drug policy challenge has leaders, in partnership with law enforcement agencies changed, the institutions must follow. Global drug policy and other relevant governmental bodies. should be created from the shared strategies of all interested multilateral agencies – UNODC of course, but With their strong focus on law enforcement and also UNAIDS, WHO, UNDP, UNICEF, UN Women, the punishment, it is not surprising that the leading World Bank, and the Office of the High Commissioner on institutions in the implementation of the drug control Human Rights. The marginalization of the World Health system have been the police, border control and military Organization is particularly worrisome given the fact that authorities directed by Ministries of Justice, Security it has been given a specific mandate under the drug or Interior. At the multilateral level, regional or United control treaties. Nations structures are also dominated by these interests. Global Commission on Drug Policy 9

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RE COMMEN D AT IO NS1. Break the taboo. Pursue an open debate DEC RIMINALIZAT IO N INIT IAT IV E S and promote policies that effectively reduce consumption, and that prevent and reduce harms DO NO T RESULT IN SIGNIFIC ANT related to drug use and drug control policies. INC REASES IN DRUG USE Increase investment in research and analysis into the impact of different policies and programs.25 Portugal In July 2001, Portugal became the first European country Political leaders and public figures should have the to decriminalize the use and possession of all illicit drugs. courage to articulate publicly what many of them Many observers were critical of the policy, believing that acknowledge privately: that the evidence it would lead to increases in drug use and associated overwhelmingly demonstrates that repressive problems. Dr. Caitlin Hughes of the University of New strategies will not solve the drug problem, and South Wales and Professor Alex Stevens of the University that the war on drugs has not, and cannot, be won. of Kent have undertaken detailed research into the effects Governments do have the power to pursue a mix of of decriminalization in Portugal. Their recently published policies that are appropriate to their own situation, findings26 have shown that this was not the case, replicating and manage the problems caused by drug markets the conclusions of their earlier study27 and that of the and drug use in a way that has a much more positive CATO Institute28. impact on the level of related crime, as well as social and health harms. Hughes and Stevens’ 2010 report detects a slight increase in overall rates of drug use in Portugal in the 10 years since2. Replace the criminalization and punishment of decriminalization, but at a level consistent with other similar people who use drugs with the offer of health and countries where drug use remained criminalized. Within this treatment services to those who need them. general trend, there has also been a specific decline in the use of heroin, which was in 2001 the main concern of the A key idea behind the ‘war on drugs’ approach Portuguese government. Their overall conclusion is that was that the threat of arrest and harsh punishment the removal of criminal penalties, combined with the use would deter people from using drugs. In practice, of alternative therapeutic responses to people struggling this hypothesis has been disproved – many countries with drug dependence, has reduced the burden of drug law that have enacted harsh laws and implemented enforcement on the criminal justice system and the overall widespread arrest and imprisonment of drug users and level of problematic drug use. low-level dealers have higher levels of drug use and related problems than countries with more tolerant Comparing Dutch and US Cities approaches. Similarly, countries that have introduced A study by Reinarman, et. al. compared the very decriminalization, or other forms of reduction in arrest different regulatory environments of Amsterdam, whose or punishment, have not seen the rises in drug use or liberal “cannabis cafe” policies (a form of de facto dependence rates that had been feared. decriminalization) go back to the 1970s, and San Francisco, in the US, which criminalizes cannabis users. The researchers wished to examine whether the more repressive policy environment of San Francisco deterred citizens from smoking cannabis or delayed the onset of use. They found that it did not, concluding that: “Our findings do not support claims that criminalization reduces cannabis use and that decriminalization increases cannabis use... With the exception of higher drug use in San Francisco, we found strong similarities across both cities. We found no evidence to support claims that criminalization reduces use or that decriminalization increases use.”29 10 Global Commission on Drug Policy

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Australia In the light of these experiences, it is clear that theThe state of Western Australia introduced a policy of harsh criminalization and punishment of drugdecriminalization scheme for cannabis in 2004, and use has been an expensive mistake, and governmentsresearchers evaluated its impact by comparing prevalence should take steps to refocus their efforts and resourcestrends in that state with trends in the rest of the country. on diverting drug users into health and social careThe study was complicated by the fact that it took place in services. Of course, this does not necessarily mean thata period when the use of cannabis was in general decline sanctions should be removed altogether – many drugacross the country. However, the researchers found that users will also commit other crimes for which they needthis downward trend was the same in Western Australia, to be held responsible – but the primary reaction to drugwhich had replaced criminal sanctions for the use or possession and use should be the offer of appropriatepossession of cannabis with administrative penalties, advice, treatment and health services to individuals whotypically the receipt of a police warning called a ‘notice need them, rather than expensive and counterproductiveof infringement’. The authors state: criminal punishments.“The cannabis use data in this study suggest that, 3. Encourage experimentation by governmentsunlike the predictions of those public commentators with models of legal regulation of drugs (withwho were critical of the scheme, cannabis use in cannabis, for example) that are designed toWestern Australia appears to have continued to decline undermine the power of organized crime anddespite the introduction of the Cannabis Infringement safeguard the health and security of their citizens.Notice Scheme.”30 The debate on alternative models of drug marketComparisons Between Different States in the US regulation has too often been constrained by falseAlthough cannabis possession is a criminal offense under dichotomies – tough or soft, repressive or liberal. In fact,US federal laws, individual states have varying policies we are all seeking the same objective – a set of drugtoward possession of the drug. In the 2008 Report of policies and programs that minimize health and socialthe Cannabis Commission convened by the Beckley harms, and maximize individual and national security.Foundation, the authors reviewed research that had been It is unhelpful to ignore those who argue for a taxed andundertaken to compare cannabis prevalence in those regulated market for currently illicit drugs. This is astates that had decriminalized with those that maintained policy option that should be explored with the samecriminal punishments for possession. They concluded that: rigor as any other.32“Taken together, these four studies indicated that states If national governments or local administrations feel thatwhich introduced reforms did not experience greater decriminalization policies will save money and deliverincreases in cannabis use among adults or adolescents. better health and social outcomes for their communities,Nor did surveys in these states show more favorable or that the creation of a regulated market may reduceattitudes towards cannabis use than those states which the power of organized crime and improve the securitymaintained strict prohibition with criminal penalties.”31 of their citizens, then the international community should support and facilitate such policy experiments and learn from their application. Similarly, national authorities and the UN need to review the scheduling of different substances. The current schedules, designed to represent the relative risks and harms of various drugs, were set in place 50 years ago when there was little scientific evidence on which to base these decisions. This has resulted in some obvious anomalies – cannabis and coca leaf, in particular, now seem to be incorrectly scheduled and this needs to be addressed. Global Commission on Drug Policy 11

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D I S C R E PANCIE S BE TWE E NL E V E L S O F CONTR OL AND LE VELS O F HA RMIn a report published by The Lancet in 2007, a team of INDEPENDENT EXPERTscientists33 attempted to rank a range of psychoactivedrugs according to the actual and potential harms they A SSESSMENT S O F RISKcould cause to society. The graph at right summarizes 0.0 0.5 1.0 1.5 2.0 2.5 3.0their findings and contrasts them with the seriousnesswith which the drugs are treated within the globaldrug control system. HeroinWhile these are crude assessments, they clearly Cocaineshow that the categories of seriousness ascribed tovarious substances in international treaties need to be Barbituratesreviewed in the light of current scientific knowledge. Alcohol KetamineU N C L AS S IF ICATION Benzodiazepines Most Dangerous Amphetamine Moderate Risk Tobacco Low Risk Buprenorphine Not Subject to International Control Cannabis Solvents LSD Ritalin Anabolic Steroids GHB Ecstasy Khat10 Global Commission on Drug Policy

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RE COMMEN D AT IO NS (Continued)4. Establish better metrics, indicators and goals to 5. Challenge, rather than reinforce, common measure progress. misconceptions about drug markets, drug use and drug dependence. The current system of measuring success in the drug policy field is fundamentally flawed.34 The impact of Currently, too many policymakers reinforce the idea most drug strategies are currently assessed by the level that all people who use drugs are ‘amoral addicts’, and of crops eradicated, arrests, seizures and punishments all those involved in drug markets are ruthless criminal applied to users, growers and dealers. In fact, arresting masterminds. The reality is much more complex. and punishing drug users does little to reduce levels The United Nations makes a conservative estimate of drug use, taking out low-level dealers simply creates that there are currently 250 million illicit drug users in a market opportunity for others, and even the largest the world, and that there are millions more involved and most successful operations against organized in cultivation, production and distribution. We simply criminals (that take years to plan and implement) have cannot treat them all as criminals. been shown to have, at best, a marginal and short- lived impact on drug prices and availability. Similarly, To some extent, policymakers’ reluctance to eradication of opium, cannabis or coca crops merely acknowledge this complexity is rooted in their displaces illicit cultivation to other areas. understanding of public opinion on these issues. Many ordinary citizens do have genuine fears about the A new set of indicators is needed to truly show the negative impacts of illegal drug markets, or the behavior outcomes of drug policies, according to their harms or of people dependent on, or under the influence of, benefits for individuals and communities – for example, illicit drugs. These fears are grounded in some general the number of victims of drug market-related violence assumptions about people who use drugs and drug and intimidation; the level of corruption generated markets, that government and civil society experts need by drug markets; the level of petty crime committed to address by increasing awareness of some established by dependent users; levels of social and economic (but largely unrecognized) facts. For example: development in communities where drug production, selling or consumption are concentrated; the level of • The majority of people who use drugs do not fit the drug dependence in communities; the level of overdose stereotype of the ‘amoral and pitiful addict’. Of the deaths; and the level of HIV or hepatitis C infection estimated 250 million drug users worldwide, the United among drug users. Policymakers can and should Nations estimates that less than 10 percent can be articulate and measure the outcome of these objectives. classified as dependent, or ‘problem drug users’.36 • Most people involved in the illicit cultivation of coca, The expenditure of public resources should therefore opium poppy, or cannabis are small farmers struggling be focused on activities that can be shown to have to make a living for their families. Alternative livelihood a positive impact on these objectives. In the current opportunities are better investments than destroying circumstances in most countries, this would mean their only available means of survival. increased investment in health and social programs, • The factors that influence an individual’s decision to and improved targeting of law enforcement resources start using drugs have more to do with fashion, peer to address the violence and corruption associated with influence, and social and economic context, than with drug markets.35 In a time of fiscal austerity, we can no the drug’s legal status, risk of detection, or government longer afford to maintain multibillion dollar investments prevention messages.37, 38 that have largely symbolic value. • The factors that contribute to the development of problematic or dependent patterns of use have more to do with childhood trauma or neglect, harsh living conditions, social marginalization, and emotional problems, rather than moral weakness or hedonism.39 Global Commission on Drug Policy 13

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RE COMMEN D AT IO NS (Continued)• It is not possible to frighten or punish someone out of drug DRUGS IN W EST AFRIC A: dependence, but with the right sort of evidence-based treatment, dependent users can change their behavior and RESP O NDING T O T HE GRO W IN G be active and productive members of the community.40 C HALLENGE O F NARC O T RAFFI C• Most people involved in drug trafficking are petty dealers and not the stereotyped gangsters from the movies – the AND O RGANIZED C RIME vast majority of people imprisoned for drug dealing or trafficking are ‘small fish’ in the operation (often coerced In just a few years, West Africa has become a major transit into carrying or selling drugs), who can easily be replaced and re-packaging hub for cocaine following a strategic shift without disruption to the supply.41,42 of Latin American drug syndicates toward the European market. Profiting from weak governance, endemic poverty, A more mature and balanced political and media discourse instability and ill-equipped police and judicial institutions, can help to increase public awareness and understanding. and bolstered by the enormous value of the drug trade, Specifically, providing a voice to representatives of farmers, criminal networks have infiltrated governments, state users, families and other communities affected by drug institutions and the military. Corruption and money use and dependence can help to counter myths and laundering, driven by the drug trade, pervert local politics misunderstandings. and skew local economies.6. Countries that continue to invest mostly in a law A dangerous scenario is emerging as narco-traffic threatens enforcement approach (despite the evidence) should to metastasize into broader political and security challenges. focus their repressive actions on violent organized Initial international responses to support regional and crime and drug traffickers, in order to reduce the national action have not been able to reverse this trend. harms associated with the illicit drug market. New evidence44 suggests that criminal networks are expanding operations and strengthening their positions The resources of law enforcement agencies can be much through new alliances, notably with armed groups. Current more effectively targeted at battling the organized crime responses need to be urgently scaled up and coordinated groups that have expanded their power and reach on the under West African leadership, with international financial back of drug market profits. In many parts of the world, and technical support. Responses should integrate the violence, intimidation and corruption perpetrated law enforcement and judicial approaches with social, by these groups is a significant threat to individual and development and conflict prevention policies – and they national security and to democratic institutions, so efforts should involve governments and civil society alike. by governments and law enforcement agencies to curtail their activities remain essential. However, there is a need to review our tactics in this fight. There is a plausible theory put forward by MacCoun and Reuter43 that suggests that supply reduction efforts are most effective in a new and undeveloped market, where the sources of supply are controlled by a small number of trafficking organizations. Where these conditions exist, appropriately designed and targeted law enforcement operations have the potential to stifle the emergence of new markets. We face such a situation now in West Africa. On the other hand, where drug markets are diverse and well-established, preventing drug use by stopping supply is not a realistic objective. 14 Global Commission on Drug Policy

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We also need to recognize that it is the illicit nature of the LAW ENFO RC EMENT ANDmarket that creates much of the market-related violence– legal and regulated commodity markets, while not T HE ESC ALAT IO N O F VIO LENC Ewithout problems, do not provide the same opportunitiesfor organized crime to make vast profits, challenge the A group of academics and public health experts basedlegitimacy of sovereign governments, and, in some cases, in British Columbia have conducted a systematic reviewfund insurgency and terrorism. of evidence45 relating to the impact of increased law enforcement on drug market-related violence (for example,This does not necessarily mean that creating a legal armed gangs fighting for control of the drug trade, ormarket is the only way to undermine the power and homicide and robberies connected to the drug trade).reach of drug trafficking organizations. Law enforcementstrategies can explicitly attempt to manage and shape In multiple US locations, as well as in Sydney, Australia,the illicit market by, for example, creating the conditions the researchers found that increased arrests and lawwhere small-scale and private ‘friendship network’ types enforcement pressures on drug markets were stronglyof supply can thrive, but cracking down on larger-scale associated with increased homicide rates and otheroperations that involve violence or inconvenience to the violent crimes. Of all the studies examining the effect ofgeneral public. Similarly, the demand for drugs from those increased law enforcement on drug market violence,dependent on some substances (for example, heroin) 91 percent concluded that increased law enforcementcan be met through medical prescription programs that actually increased drug market violence. The researchersautomatically reduce demand for the street alternative. concluded that:Such strategies can be much more effective in reducingmarket-related violence and harms than futile attempts “The available scientific evidence suggests thatto eradicate the market entirely. increasing the intensity of law enforcement interventions to disrupt drug markets is unlikely to reduce drug gangOn the other hand, poorly designed drug law enforcement violence. Instead, the existing evidence suggests thatpractices can actually increase the level of violence, drug-related violence and high homicide rates are likelyintimidation and corruption associated with drug a natural consequence of drug prohibition and thatmarkets. Law enforcement agencies and drug trafficking increasingly sophisticated and well-resourced methods oforganizations can become embroiled in a kind of ‘arms disrupting drug distribution networks may unintentionallyrace’, in which greater enforcement efforts lead to a similar increase violence.”46increase in the strength and violence of the traffickers.In this scenario, the conditions are created in which the In the UK also, researchers have examined the effects ofmost ruthless and violent trafficking organizations thrive. policing on drug markets, noting that:Unfortunately, this seems to be what we are currentlywitnessing in Mexico and many other parts of the world. “Law enforcement efforts can have a significant negative impact on the nature and extent of harms associated with drugs by (unintentionally) increasing threats to public health and public safety, and by altering both the behavior of individual drug users and the stability and operation of drug markets (e.g. by displacing dealers and related activity elsewhere or increasing the incidence of violence as displaced dealers clash with established ones).”47 Global Commission on Drug Policy 15

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RE COMMEN D AT IO NS (Continued)7. Promote alternative sentences for small-scale and rates of drug use through mass prevention campaigns first-time drug dealers. were poorly planned and implemented. While the presentation of good (and credible) information on While the idea of decriminalization has mainly been the risks of drug use is worthwhile, the experience of discussed in terms of its application to people who use universal prevention (such as media campaigns, or drugs or who are struggling with drug dependence, school-based drug prevention programs) has been we propose that the same approach be considered mixed. Simplistic ‘just say no’ messages do not seem for those at the bottom of the drug selling chain. to have a significant impact.49 The majority of people arrested for small-scale drug selling are not gangsters or organized criminals. There have been some carefully planned and targeted They are young people who are exploited to do the prevention programs, however, that focus on social skills risky work of street selling, dependent drug users trying and peer influences that have had a positive impact on to raise money for their own supply, or couriers coerced the age of initiation or the harms associated with drug or intimidated into taking drugs across borders. These use. The energy, creativity and expertise of civil society people are generally prosecuted under the same legal and community groups are of particular importance provisions as the violent and organized criminals who in the design and delivery of these programs. Young control the market, resulting in the indiscriminate people are less likely to trust prevention messages application of severe penalties. coming from state agencies. Around the world, the vast majority of arrests are of Successful models of prevention have tended to target these nonviolent and low-ranking ‘little fish’ in the drug particular groups at risk – gang members, children in market. They are most visible and easy to catch, and do care, or in trouble at school or with the police – with not have the means to pay their way out of trouble.48 mixed programs of education and social support that The result is that governments are filling prisons with prevent a proportion of them from developing into minor offenders serving long sentences, at great cost, regular or dependent drug users. Implemented to a and with no impact on the scale or profitability of sufficient scale, these programs have the potential the market. to reduce the overall numbers of young people who become drug dependent or who get involved in In some countries, these offenders are even subject to petty dealing. the death penalty, in clear contravention of international human rights law. To show their commitment to 9. Offer a wide and easily accessible range of options fighting the drug war, many countries implement laws for treatment and care for drug dependence, and punishments that are out of proportion to the including substitution and heroin-assisted treatment, seriousness of the crime, and that still do not have a with special attention to those most at risk, including significant deterrent effect. The challenge now is for those in prisons and other custodial settings. governments to look at diversion options for the ‘little fish’, or to amend their laws to make a clearer and more In all societies and cultures, a proportion of individuals proportionate distinction between the different types of will develop problematic or dependent patterns of actors in the drug market. drug use, regardless of the preferred substances in that society or their legal status. Drug dependence can be8. Invest more resources in evidence-based prevention, a tragic loss of potential for the individual involved, with a special focus on youth. but is also extremely damaging for their family, their community, and, in aggregate, for the entire society. Clearly, the most valuable investment would be in activities that stop young people from using drugs in Preventing and treating drug dependence is therefore the first place, and that prevent experimental users a key responsibility of governments – and a valuable from becoming problematic or dependent users. investment, since effective treatment can deliver Prevention of initiation or escalation is clearly preferable significant savings in terms of reductions in crime and to responding to the problems after they occur. improvements in health and social functioning. Unfortunately, most early attempts at reducing overall 16 Global Commission on Drug Policy

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Many successful treatment models – using a mix of UN drug control institutions have largely acted as substitution treatment and psycho-social methods defenders of traditional policies and strategies. In the – have been implemented and proven in a range of face of growing evidence of the failure of these strategies, socio-economic and cultural settings. However, in reforms are necessary. There has been some encouraging most countries, the availability of these treatments is recognition by UNODC that there is a need to balance limited to single models, is only sufficient to meet a and modernize the system, but there is also strong small fraction of demand, or is poorly targeted and fails institutional resistance to these ideas. to focus resources on the most severely dependent individuals. National governments should therefore Countries look to the UN for support and guidance. develop comprehensive, strategic plans to scale The UN can, and must, provide the necessary leadership up a menu of evidence-based drug dependence to help national governments find a way out of the current treatment services. policy impasse. We call on UN Secretary General Ban Ki-moon and UNODC Executive Director Yury Fedotov At the same time, abusive practices carried out in the to take concrete steps toward a truly coordinated and name of treatment – such as forced detention, forced coherent global drug strategy that balances the need labor, physical or psychological abuse – that contravene to stifle drug supply and fight organized crime with the human rights standards by subjecting people to cruel, need to provide health services, social care, and economic inhuman and degrading treatment, or by removing development to affected individuals and communities. the right to self-determination, should be abolished. Governments should ensure that their drug dependence There are a number of ways to make progress on this treatment facilities are evidence-based and comply with objective. For a start, the UN could initiate a wide- international human rights standards. ranging commission to develop a new approach; UN agencies could create new and stronger structures for10.The United Nations system must provide leadership policy coordination; and the UNODC could foster more in the reform of global drug policy. This means meaningful program coordination with other UN agencies promoting an effective approach based on evidence, such as the WHO, UNAIDS, UNDP, or the Office of the supporting countries to develop drug policies UN High Commissioner for Human Rights. that suit their context and meet their needs, and ensuring coherence among various UN agencies, 11. Act urgently: the war on drugs has failed, and policies and conventions. policies need to change now. While national governments have considerable There are signs of inertia in the drug policy debate in discretion to move away from repressive policies, some parts of the world, as policymakers understand the UN drug control system continues to act largely that current policies and strategies are failing but do not as a straitjacket, limiting the proper review and know what to do instead. There is a temptation to avoid modernization of policy. For most of the last century, the issue. This is an abdication of policy responsibility – it has been the US government that has led calls for for every year we continue with the current approach, the development and maintenance of repressive drug billions of dollars are wasted on ineffective programs, policies. We therefore welcome the change of tone millions of citizens are sent to prison unnecessarily, emerging from the current administration50 – with millions more suffer from the drug dependence of President Obama himself acknowledging the futility loved ones who cannot access health and social care of a ‘war on drugs’ and the validity of a debate on services, and hundreds of thousands of people die from alternatives.51 It will be necessary, though, for the US to preventable overdoses and diseases contracted through follow up this new rhetoric with real reform, by reducing unsafe drug use. its reliance on incarceration and punishment of drug users, and by using its considerable diplomatic influence There are other approaches that have been proven to to foster reform in other countries. tackle these problems that countries can pursue now. Getting drug policy right is not a matter for theoretical or intellectual debate – it is one of the key policy challenges of our time. Global Commission on Drug Policy 17

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G L O B A L COMMIS S ION ON D R U G PO LICY The purpose of the Global Commission on Drug Policy is to bring to the international level an informed, science-based discussion about humane and effective ways to reduce the harm caused by drugs to people and societies. GOALS • Review the basic assumptions, effectiveness and consequences of the ‘war on drugs’ approach• Evaluate the risks and benefits of different national responses to the drug problem• Develop actionable, evidence-based recommendations for constructive legal and policy reform www.globalcommissionondrugs.org 22 Global Commission on Drug Policy